Provider Demographics
NPI:1881667160
Name:JABEKA INC.
Entity Type:Organization
Organization Name:JABEKA INC.
Other - Org Name:FRANZ OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-689-1115
Mailing Address - Street 1:65 DIVISION AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2485
Mailing Address - Country:US
Mailing Address - Phone:541-689-1115
Mailing Address - Fax:541-688-5585
Practice Address - Street 1:65 DIVISION AVE
Practice Address - Street 2:SUITE E
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2485
Practice Address - Country:US
Practice Address - Phone:541-689-1115
Practice Address - Fax:541-688-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1856T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3021OtherNORTHWEST BENEFIT NETWORK
ORDO9351OtherRAILROAD MEDICARE PTAN
OR083019Medicaid
OR02501-01OtherPACIFIC SOURCE
OR049169002OtherBLUE CROSS
OR111228OtherEYEMED
OR049169002OtherBLUE CROSS
OR3021OtherNORTHWEST BENEFIT NETWORK
OR083019Medicaid
OR1266170001Medicare NSC